electrical inspection RX Date/Time 11/02/2020 15:15 15182731202 P.002
,::, Nov, 2. 2020 2:55P ;;�;,;.MDIA .No. •5223 P• 2/3
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MIDDLE DEPARTMENT INSPECTION AGENCY, INC. c4
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�J�; ty that the electrical wiring to the electrical equipment listed below has been examined and is approved as
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,i being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date I,'$
1.;1 noted below and is issued subject to the following conditions. �\?
.,. Owner: Batt Johnson Date: r
4 10/22/2020 `�r=
O Occupant:• Pool Location:. (g)
(-,� 1 Apres Cir, 0
Occu ancv• • Queensbu Warren Co- NY �1
?' p Swimming Pool ry' r" j
Cyr ;Applicants GBM Electrical - -
k Attn:Matthew Wing • . • •
0 69 Peggy Ann Road _. . _ L•..
(e, L Queensbury NY 12604,•" _ S`ti
, Joseph A.HoI 0.
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(@ No. mes :';:
_ � -- — _,•147929t48_019:EL - - - - - - - - - - - - - -. yJ.
6 `Equipment:
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(4 -Lights; 1 -Heat Pump;2 Switclies;5-Receptacles;'3.-•Fixtures;t-Pool Pump;-1l-Twist=L
2 ock Receptacle �'
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TOWN OF OUEEI\SBURY
BUILDING&CODES -
. This certificate applies to the electrical wiring to the electrical equipment listed Immediately null and void. This certificate applies only to the use,occupancy and v�
Cv� above and the Installation inspected as of the above noted date based on a visual ownership as indicated herein. Upon a change In the use,occupancy or ownership t)
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inspection. No warranty Is expressed or implied as to the mechanical safety,ell- of the property indicated above,this certificate shall be Immediately nun and void. (
ciency or rdness of the equipment for any particular purpose. This certificate shall In the event that this certificate becomes Invalid based upon the above conditions, >r
W be valid fora perloa of one year from the above noted date. Snould the electrical this certificate may be revalidated upon reinspecrion by Middle Department >>
•.- system to which this certificate applies be altered in any way.including but not limit- Inspection Agency.Inc. An application for inspection must be submitted to Middle ()
•3 ed to,the introduction of additional electrical equipment and/or the replacement of Department Inspection Agency, Inc.to initiate the inspection end revalidation lea)
(•>) any of the components installed es of the above noted date,this certificate shall be process, A fee will be charged for this service- -�'�
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